MEDICARE: DR. ANTHONY BLAKE FIELDS PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202206562	VA

General Provider Information

NPI Number	:	1417221664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY BLAKE FIELDS PHARM D

Provider Business Mailing Address
First Line	:	5015 MAIN ST
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-3003
Country	:	US
Telephone Number	:	540-869-1660
Fax Number	:	540-869-1463

Provider Business Practice Location Address
First Line	:	5015 MAIN ST
Second Line	:
City	:	STEPHENS CITY
State	:	VA
Zip	:	22655-3003
Country	:	US
Telephone Number	:	540-869-1660
Fax Number	:	540-869-1463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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